NAME: ______________________________________________ DOB: ______________________
ADDRESS: _______________________________________________________________________
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EMAIL: __________________________________________________________________________
HOME PHONE: ________________________ WORK PHONE: ____________________________
SEASONAL PHONE: ______________________ CELL PHONE: ___________________________
SPECIAL SKILLS, LICENSES & CERTIFICATIONS: ____________________________________
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MEDICAL CONDITIONS & ALLERGIES: ______________________________________________
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DESIRED MEMBERSHIP CLASSIFICATION
(Click Here for an explanation of Membership Classifications):
CHECK ONE: FIELD FIELD WINTER ADMINISTRATIVE
ASSOCIATE PROFESSIONAL
WILL RESPOND TO SEARCHES OUTSIDE CASART AREA
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SIGNATURE_________________________________________DATE_____________________
INITIATION FEE: $15.00 DUES: $10.00
HAT, CASART & NYSFEDSAR PATCHS & MEMBERSHIP CARD ISSUED
To become a member print out this form, complete it and return it with your
$15 initiation fee and $10 annual dues to: CASART, Inc. P.O. Box 143, Inlet, NY 13360